Tammie - Drug & Alcohol Nursing

My name is Tammie Breneger and I work in community drug and Alcohol as an RN. I have worked in both withdrawal management and the opioid substitution treatment program. I completed my grad year rotations in HDU and IPU and my goal was to become and ED NP however I have found my calling and love the challenge and complexity of this field everyday.

Thanks for chatting with me today Tammie!

I’m not sure how many people would be interested in drug and alcohol nursing.

Me for one! And I think a lot of people are curious but not sure where to start! So can I start with where did you train and what was your first job as a nurse?

So I did my BN at SCU Coffs Harbour 2015-2107. Grad year at Kempsey district hospital and now 2 years in community drug and alcohol in Kempsey. So I completed my grad year in ICU/HDU and medical ward. Unfortunately i stepped on some toes whilst I was a grad because I wouldn’t accept the poor clinical practice and shit culture in that hospital... long story short I was unsuccessful in gaining full time employment post my grad year, but they needed me so kept me on a casual. I wasn’t happy with this situation and one of my mentors suggested looking outside the acute system and using some of my other professional skills (ex-cop) and drug and alcohol had a job going. At first it just fulfilled my need for ft employment but I quickly developed a passion for it as it is so clinically complex and requires the full gamut of skills; communication, clinical reasoning, negotiation and conflict resolution and advocacy.

Wow ex-cop! What are the skills that you find come in handy from that career that you use in nursing?

Conflict resolution and negotiation, risk assessment, de-escalation techniques, time management and resilience.

That's amazing! So drug and alcohol nursing. Could you tell us more about what the nurses role is in this area?

My role in a community free dosing clinic is running a methadone dosing clinic 7 days a week for 2 hrs each day. We have Dr clinics 3 days a week where we conduct nursing assessments and assist where necessary with admin stuff plus pathology collection. We now dispense a monthly sub cut depot treatment as well so that takes time and is fascinating... so much so I doing an original research study for my masters on the psycho-social impacts of the new treatment. We also facilitate medicated alcohol and cannabis detox both inpatient and outpatient. Our service has 200 current clients.

Could you tell us more about the support you provide during detox?

We work with our drs and client to undertake a 7-10 day detox with daily check ins, medication dispensing, education and support and relapse prevention support. Additionally, advocacy with other continuing care providers like rehabs.

Whats the best thing about drug and alcohol nursing and the hardest thing?

I personally love the challenge of medicine smacking up against trauma informed care, crashing into autonomy of treatment for the client and being at the cutting edge of new medications. The hardest part of my day ironically is dealing with other clinicians who don’t/won’t/can’t acknowledge addiction alongside other chronic illnesses.

Yes I think addiction is a really difficult thing for many to understand. I sympathise but I have trouble personally understanding. Do you have any advice for those who are trying to understand?

I guess the biggest thing to get your head around is you will never understand why someone is addicted... they really don’t know either. Always working in a trauma-informed care model gives great insight into the disease and it’s processes. I’ll ask you a question, would you judge an obese person with T2DM and maybe react poorly to them as patients? Or disparage someone who has heart disease and continues to eat crap food and not exercise and call them drug seekers when they present to hospital? This is what I hear daily from clinicians about my clients, hell I used to say exactly the same thing before I started in my unit. The problem is we treat certain chronic illness with respect and compassion and empathize with the restrictions it places on someone’s life, yet with addiction they are junkies, they could stop if they wanted, they’re just drug seeking cause they’re broke!!

That is an amazing way to look at it! Thank you that really puts things in perspective. What would you say to someone who is looking to move into drug and alcohol nursing?

Do it!!!! But leave all your preconceptions at the door and be willing to go on a journey with your clients!!!

Do you need to have post grad training in the area before you start?

No not at all.

Did you find it a bit of a mind shift between being a cop and being a drug and alcohol nurse or where there some similarities?

There are a lot of parallels between the two - risk management, conflict resolution and negotiation, using different communication styles. And sadly, very similar prejudices and attitudes... including my own initially.

And what is your best memory or the thing that will stick with you from your role as a drug and alcohol nurse?

I think my critical thinking and communication skills have been honed to precision being in drug and alcohol. Also I have a new awareness and understanding of trauma informed care and realize that it is still so poorly executed in most healthcare settings and it has broader implications across all first responder professions.

Do you have any ideas on how the wider community can educate ourselves to better understand trauma informed care? Any resources that you find useful?

The NSW health resources are excellent and information is readily available on the web. Ask yourself this question, if that were me walking in the world of addiction how would I want to be treated ?? It’s a powerful tool.

Thank you so much for sharing all of this with me. Is there anything else you wanted to comment on?

Mmm, I think I have stood on my soap box for long enough but I am happy to chat some more if you need any more stuff.

Amazing! Thank you! I do open up the blog to questions so may come back to you if need be.

If you would like to be interviewed or write a guest post for the Nurse Life blog please get in contact at nurselifeaus@gmail.com

Stay safe brothers and sisters!